Large gap between attitude and action in tuberculosis preventive treatment among tuberculosis-related healthcare workers in eastern China

Abstract

Healthcare workers (HCWs) are at a high risk for latent tuberculosis infection (LTBI) because of occupational exposure, and the attitudes and behaviors of frontline tuberculosis (TB)-related HCWs toward preventive treatment of LTBI in eastern China remain unknown. This study aimed to explore the attitudes and actual behaviors of TB-related HCWs toward TB preventive treatment (TPT) and to analyze the relevant factors influencing the attitudes of HCWs. A stratified random sample of 28 TB-designated hospitals was selected in Zhejiang Province, China. All TB-related HCWs in the selected hospitals were recruited to answer questionnaires and were tested for LTBI by the TB interferon gamma release assay. TPT use was assessed two years after the survey. Univariate analysis and binary logistic regression models were used to analyze the factors influencing the TPT intention of HCWs. A total of 318 TB-related HCWs were recruited from 28 TB-designated hospitals; 62.3% of them showed positive attitudes toward TPT, while the rest were reluctant to treat positive LTBI prophylactically. binary logistic regression analysis revealed that the factors influencing the attitudes of HCWs were mainly education level, household income, history of alcohol consumption, and workplace. The IGRA test found that 35.2% (112/318) of HCWs tested positive for LTBI. Most people refused treatment because of drug side effects, followed by the belief that treatment was ineffective, wanting to wait until the onset of the disease, and that it was too much trouble to take the medication. According to the results of a follow-up survey, only one of these HCWs underwent TPT, and the consistency rate of attitudes and behaviors was 36.6% (41/112). This study reveals different attitudes toward TPT among TB-associated HCWs in eastern China and a large gap between attitudes and actual action. The management of HCWs with LTBI still needs further strengthening.

Intention to receive Latent Tuberculosis Infection (LTBI) treatment and its associated factors among healthcare workers in a Malaysian teaching university hospital

“…The outcomes of this study disclosed that 53.5% of the HCWs serving in the selected teaching hospital had positive intention to receive LTBI treatment. The reported figure, however, was lower than that reported in 2017 for the Eastern China context displaying 62.3% willingness to receive LTBI treatment [ 46 ]. In India, 73.5% of non-HCWs with TB close contact disclosed positive intention to receive LTBI treatment [ 47 ].…”

“…Meanwhile, a higher percentage of Indians had stronger and more positive intent to receive LTBI treatment because of their close contact with TB patients in their households. Evidently, the two studies from India and Eastern China had samples that were in close contact with TB patients or worked around them [ 46 , 47 ]. Such a situation led the samples to have a high willingness to seek LTBI treatment stemming from high susceptibility to contracting TB [ 48 ].…”

Population-level health and economic impacts of introducing Vaccae vaccination in China: a modelling study

“…Individuals receiving TPT bear the risk of adverse effects such as severe or even fatal drug-induced hepatitis 28. Unfortunately, TPT coverage is low even in HCWs in China 29. In addition, potent new diagnostic tools, such as M. tuberculosis culturing and Xpert MTB/RIF tests, are limited to major hospitals 30.…”

“…28 Unfortunately, TPT coverage is low even in HCWs in China. 29 In addition, potent new diagnostic tools, such as M. tuberculosis culturing and Xpert MTB/RIF tests, are limited to major hospitals. 30 According to our study, vaccination with Vaccae is insufficient to control the disease to meet the WHO's goals.…”

Willingness to use long-acting injectable PrEP among HIV-negative/unknown men who have sex with men in mainland China: A cross-sectional online survey

“…Long-term use of PrEP pills has been associated with liver and kidney problems, as well as decreased bone density. Additionally, a previous study conducted in eastern China found that healthcare workers chose side effects as the main reason for being unwilling to accept tuberculosis prevention treatment [ 68 ]. Furthermore, due to traditional cultural beliefs about medicine, it is widely acknowledged in China that all drugs have some toxicity and that individuals are unwilling to take medicine until they have symptoms, which also acts as a roadblock to PrEP uptake among MSM at high risk of HIV infection [ 69 ].…”